| NPI | 1972913127 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 207P00000X Emergency Medicine (Licence: NV 28932) |
| Additional Taxonomies | 207P00000X Emergency Medicine (Licence: NC 2016-02404) |
| 390200000X Student in an Organized Health Care Education/Training Program | |
| Enumeration Date | 2014-04-28 |
| Last Update Date | 2026-03-27 |